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4__� <br /> -------------------------------—------------- This Permit Expires I Year From Date Issued Date Issued _::�-5/z4o <br /> Applicatio r n is hereby made to the San Joaquin Local Health D,is r' t for a permit to construct and iristap, the work herein described. <br /> This application is made in compliqn��-y Or <br /> dinairc-e No. 549. g <br /> _ '�____'__''-- Phone-- ------- <br /> . ' <br /> Adu ----------------------------------------------------------------------------------------------------------------------------_-- <br /> � <br /> Contractor's Nome_.x�^�^���-��-�.��''_---.----_---�---_----.--_--.-------.--.. rh,ne-'_-.---_-_--' <br /> � |n��Um��n �� ��: Residence JB'_ A��mont House � (�mmn�m| E] Trailer CourtCourtElMotel [3 Other <br /> ' � <br /> Number of living units: - -r <br /> �- Number bedrooms _ <br /> Number of��u+�s I-' Lot size �; J~ »� /"��� -.-..-'----- <br /> a '"���--_--'-,-_- <br /> Water Supply: Public system [] Community system El P-rivate 0 Depth mWater Table ft <br /> Character of soil to w depth of 3 feet: Sand [] Gravel [] Sandy Loom [] Clay Lnam�[] Clay [] Adobe E}- Hardpan [l <br /> _ <br /> Previous Application Made: (If yes,date------------------`-} Noe New Construction: Yes D2~~No [] PHA/VA. Yes [] No Dg-~~ <br /> ' 7y9E OfINSTALLATION AND SPECIFICATIONS: ' ~ <br /> (No septic tank or cesspool permitted ifFmbric sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well Distance from foun6 �u+|on-� .�--- Material <br /> . ! � ! <br /> . . �.No. ofcompartnen6-x�*-----.Size-- � -'-'�qui� �ept6-. -----Copucity-K? <br /> D- F��� D�+um:n 6'om nearest w�|--�-'-D|�unco from ------------Distance to nouro� �t |�e-o_a-�~'~'-� <br /> �-..- <br /> Num6mr of lines ' -Lomo+ of each |i of +mnch-� X-u_--__ <br /> Tvno of fi|+or ma+m�� °~ ^ Deo� of filter material � .._.Total length------ � �--._--_--' <br /> 0, <br /> \�\ <br /> 3ewp�m�� F��: Di��ncoto nearest well ------.Distanco from foundation----1?,_ -Dista'mce to nearest �. |" ., A <br /> ----------- <br /> Number <br /> of pO�--/--._-Un|ng muto�ai7�(�_--S�o: Diameter .-�--' <br /> pool: Distance from nearest well------------ from foundation--------------------Lining material --_---_-- <br /> ] Size: Diameter Depth-----------------------------------------------------Liquid �"p"` r ' -gab. <br /> _-gals- <br /> Privy. <br /> Distance from no�m«+ weU '-_-''-''�-''-''---D�+once fnm� neo,no 6ui|d|ng''-''--'-_-_--'-- ' <br /> [] Distance to nsm,est.|ctline-------------------------------------------------._-_-_''-_.-.__-_._--_.-------._.� <br /> Rmmo6eling and/or repairing (describe):- -. ----------------------------_---.--_------------------------------------------------------------------------------------------- <br /> '_------_-_--_--____-._---__-�____--__..--''- ------------------------------------------------------------------ --------------------------------- <br /> '--------------'---------'------------'--'----------'------'--''--''----'--'---- <br /> \ ---------'--'---''-----'---------=''--f:----------- --'----'----------------'-'----'---- <br /> I hereby certify that I have preparea'+hi� al�pliclfion and that-the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> size of lot. location of system in relatibn to weII4 buildings, efc.. can be placed on reverse side). <br /> | ------------- <br /> (Plot plan, Showing <br /> FOR DEPARTI�4ENT USE ONLY� <br /> --------------------------------------- <br /> DATE <br /> , '/ ^--- <br /> .-_,�����-.-�.�.-.c- �-��.x��,._--�`-=.*--.^—^-^�^^-^--'---'-----------------'--- <br /> ! ''-'-----'~-'-''--'--'�-''---''-''-'---'-''--'''-_.'-_''^---''-'-_''-''-''-'-'''-'''-''----''-- <br /> � <br /> -------------------------------_---------------------------------------------------- -----------''-''''-_''-''''-''-.'-'''-''-''--------------- -------------------------------- <br /> ' <br /> ........... _----_-----__-- ................. ---------------------------------------- --------------------------------- --------------------------------------------------- <br /> RN/\L INSPECTION 8Y;'- ��' --------- Date----- --------- -_'-''----'- <br /> | SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> � <br /> 130 South American Street uwwWest Oak Street 12*Sycamore Street upsWest 9th Street <br /> omxk,00'naof*,"/o L"a/'California Manteca,California Tracy,California <br /> cs 9 nuw5En 5m9 um 5'62 ^`L^n <br />